Behavioral medications have gained widespread use and now account for 11% of total pharmacy plan costs, according to Medco Health Solutions' 2006 Drug Trend Report. The number of adults using antidepressants increased 17% from 2001 through 2005, while the number of patients using antipsychotic and ADHD drugs during that period rose 13% and 88%, respectively. Potentially contributing to this overall growth is the fact that the newer behavioral medications have fewer side effects than their predecessors, but concerns about safety have not gone away.

Integrated data-based health and safety systems can prevent medication errors by accessing medical, pharmacy, and laboratory records, reviewing the data for potential risks, and alerting physicians and pharmacists about potential problems. One such system, Medco's RationalMed Patient Health and Safety System, issued more than 319,000 alerts to pharmacists and doctors in 2005 regarding behavioral medications (approximately one-fifth of RationalMed's 1.5 million alerts last year). Therapy changes from the alerts resulted in more than $7 million in pharmacy savings for benefit providers participating in the RationalMed program, which had 9 million enrollees in 2005. But beyond the drug cost savings, by catching problems before they occur, these programs can substantially cut down on the additional medical care and hospital costs often associated with prescription drug errors.

Senior patients are particularly vulnerable to medication-related problems. In fact, members at least 65 years old accounted for more than 37% of RationalMed's behavioral medication alerts last year, resulting in 19% of the savings garnered through the program. In general, seniors take more medications, see more physicians, and use more pharmacies than younger patients and, therefore, are at a greater risk of medication-related problems. According to a 2005 Medco report on senior polypharmacy, about 1 in 4 seniors received prescriptions from 5 or more doctors, 1 in 20 were prescribed medications by 8 or more physicians, and nearly one-quarter of these seniors filled their prescriptions at 3 or more pharmacies, with some using as many as 11 different pharmacies in 1 year.

On top of that, seniors are affected by drugs differently because of their liver's diminished ability to metabolize drugs and the kidneys' diminished ability to excrete them. Reduced drug elimination often extends the half-life of drugs, which means prescribers should alter how they are administered. Unfortunately, inappropriate doses of prescription drugs often are taken by older patients. The most common side effects of excessive dosing with antidepressants, anxiety treatments, and sleeping pills in senior patients are confusion and drowsiness, resulting in a greater likelihood of falls or car accidents. …

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